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Esophageal Cancer - Diagnosis and Staging

Rod Taylor Thoracic Care Center

Diagnosis and Staging

Diagnosis and staging of esophageal cancer is critical to receive the most appropriate treatment in a timely manner. Working with a team with expertise in esophageal cancer is important to achieve the best possible outcome.

Patients are typically diagnosed in the following scenarios:

Incidental Finding - Patients undergoing esophagogastroduodenoscopy (EGD) for GERD who are asymptomatic can present with early stage cancer. Patients with abnormal X-ray findings such as liver nodules or bone lesions, present with advanced disease.

Symptoms - Patients with early stage disease are usually asymptomatic. Symptoms that are sometimes present are:

  • Difficulty Swallowing - usually starts with trouble swallowing solid foods that then progresses to liquids.
  • Heartburn - Usually associated with GERD, but can be a sign of cancer.
  • Regurgitation - Also usually associated with GERD, but can be a sign of cancer.
  • Hematemesis - Vomiting of blood
  • Weight loss

When esophageal cancer is suspected, a biopsy may be performed. There are several methods for biopsy including radiology needle biopsies, endoscopy exam, and surgery. The goal is to obtain tissue for the pathologist to examine and diagnose the type of cancer. Our team can determine quickly the most effective method for diagnosis and treatment, often avoiding unnecessary tests and delays in treatment.

It is important to assess the location of the cancer, the depth of invasion, lymph node involvement, and possible distant sites of spread in order to discuss treatment options. Several tests can be done for staging, some of these are:

Esophagogastroduodenoscopy (EGD) - This is a flexible camera placed through the month to look at the esophagus, stomach, and duodenum. It can be used to biopsy the tumor and determine the location of the tumor.

Endoscopic Ultrasound (EUS) - This is a flexible camera with an ultrasound probe at the end and is used to view the layers of the esophagus to assess the depth of invasion and lymph node involvement.

CT/PET Scan - A study that uses a radioactive labeled sugar molecule that is trapped by cancer tissue and then is visible on a scan picture. This is helpful to determined if cancer has spread outside of the esophagus.

This process is important for determining the severity of esophageal cancer and developing the best available treatment plan. Once the process is complete, your physician will discuss the results with you and recommend a personalized treatment plan.